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The HKU E-learning Platform in Clinical Medicine
The HKU E-learning Platform in Clinical Medicine
  • Physical Examination Skills
    • General Examination
    • Examination of the Cardiovascular System
    • Examination of the Gastrointestinal System
    • Examination of the Neurological System
    • Examination of the Respiratory System
    • Examination of the Musculoskeletal System
    • Demonstration on putting on a surgical/ N95 mask properly
  • eLearning Materials of Individual Divisions
    • Cardiology
    • Clinical Pharmacology
    • Dermatology
    • Endocrinology
    • Gastroenterology & Hepatology
    • Geriatrics
      • Common Physical Signs in the Geriatric Setting
      • Commonly used Assessments in the Geriatric Setting
    • Haematology
    • Infectious Diseases
    • Nephrology
      • General Nephrology
      • Imaging
      • Peritoneal Dialysis
      • Hemodialysis
    • Neurology
    • Rehabilitation Medicine
      • Modified Ashworth Scale
      • Complex Regional Pain Syndrome
      • Case 1
      • Case 2
    • Respiratory Medicine
    • Rheumatology
      • Common Rheumatological Cases
      • Clinical Signs and Radiographs of Patients with Rheumatological Disorders
  • Credits
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Infectious Diseases

Necrotizing Fasciitis

November 29th, 2014

Necrotizing Fasciitis

History

  • 51 years old man
  • Presented with 5 days history of severe left lower limb pain
  • Associated with fever, chills, nausea, vomiting, diarrhea and numerous blister lesions over the left lower limb
  • Fishing in Lamma Island 3 days before symptom onset
  • Good past health
  • Not on long term medications
  • Drank 2 pints of beer per day, non-smoker

Physical Examination

  • Septic and lethargic
  • T 40°C
  • BP 60/40 mmHg
  • PR 120 bpm
  • RR 30/min
  • SaO2 90% on room air

Investigations

  • WCC 33 x 109/L; neutrophil 60%
  • Hb 12 g/dL
  • Platelet 122 x 109/L
  • INR 2
  • CK 2350 U/L
  • Creatinine 230 umol/L
  • ALT 145 U/L AST 465 U/L

Differential Diagnosis

  • Gp A streptococcus
  • Vibrio vulnificus
  • Aeromonas hydrophila
  • Clostridium septicum
  • Staphylococcus aureus

Diagnosis

  • Clinical diagnosis of necrotizing fasciitis
  • Blood and tissue culture from debridement: Aeromonas hydrophila

Treatment

  • Intravenous 3rd or 4th generation cephalosporins
  • Surgical debridement of devitalized tissue as necrotizing fasciitis

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